Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

Información del documento
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Título
Descripción

This form is not available to download. If you are an injured worker, ask your medical provider for a copy of this form or you can complete your portion of the Report of Accident (ROA) online at https://secure.Lni.wa.gov/home.

Please note only medical providers may order this form from the Warehouse.

Detalle
Número del formulario F242-130-000
Disponibilidad solicítelo
Palabras claves accident report, claim information, claims, coverage, diseases, espanol, industrial insurance, medical forms, occupational diseases, occupational injuries, report of injury or occupational disease, reporting accidents, worker's compensation, workers compensation, workers' compensation
Idiomas English, Spanish
Fechas válidas 10-2012
Contacto
Páginas de Internet Workers' Comp Claims

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